Organized medicine's new turf: e-services

Stodgy medical societies are partnering with, and creating, online companies. What can they do for your practice?

By Wayne J. Guglielmo
Senior Editor

Internist Robert Meacham of Hernando, MS, sounds like a kid with a new toy when he talks about his just-completed practice Web site.

"It will allow us to post announcements, respond to routine questions, refill prescriptions, profile staff, and list who's in the office at what time," he says. "I'm very excited about it."

Meacham's new site is produced by Medem, a for-profit company founded in 1999 by the AMA and six other medical societies, along with several outside investors. The initial idea was to enable doctors to provide high-quality clinical data to their patients, as well as other services. But the company expanded the Web sites to include other information, too.

Since Medem's official launch last June, 27 more societies have signed partnership agreements, including Meacham's own Mississippi State Medical Association. About 27,000 physicians have joined the Medem network, according to company figures. Except for those requesting advertising-free sites, the service for now is a no-charge member benefit.

Organized medicine's foray into e-commerce isn't limited to Medem. In state after state, as well as at the national level, medical societies have jumped on the e-commerce bandwagon. Some have seen a market niche and created new companies. More typically, doctor organizations have partnered with existing online companies to form joint ventures.

For the societies, the ventures are a way to remain relevant. "Our digital partnerships help us to reconnect with physicians," says Bob Musacchio, the AMA's senior vice president of publishing, membership, and business services.

For e-companies, the partnerships offer legitimacy within the physician community—as well as a nifty marketing base. Critics have grumbled about the cozy arrangements, but signs indicate the partnerships will not only continue but expand. We took a look at some of the major Web-based activity to see what it all means for you.

Practice sites with all the bells and whistles

For the AMA, entry into the e-marketplace was a matter of survival. "If we left online services to the WebMDs and Medscapes of the world, it would be just a short leap for our members to ask why they needed the AMA at all," says Musacchio.

Medem officials are buoyed by surveys, theirs included, that show roughly 50 percent of physicians currently have practice Web sites. The trick now, everyone agrees, is to get doctors to trade in their rudimentary sites for online presences "with embedded secure messaging and all the bells and whistles," in the words of Medem CEO Edward J. Fotsch, an emergency medicine specialist turned e-commerce executive.

He's especially high on the prospects of paid online consultations, and Medem is developing software that will help doctors create billing schedules for those consultations. To illustrate their potential, he cites the example of a 55-year-old woman with a history of breast cancer and heart disease, who wants to talk to her doctor about hormone replacement therapy. Right now, the woman's only option is to show up at her doctor's office, says Fotsch. "But move this discussion online, with all the data on women's health that can be appended, and doctors can provide a far better answer in less time."

Some doctors are already using their Medem sites to consult with patients, even in the absence of online fees. One is Amesbury, MA, ob/gyn Joseph M. Heyman. "A patient of mine was concerned about some surgery I was scheduled to perform on her," says Heyman. "On an Internet site linked to mine, she'd learned that one of the potential contraindications of the surgery was a previous C-section, which she'd had. 'How come you can do this on me?' she asked in an e-mail. I was amazed I'd missed this, but I went to the same site and found out that the danger wasn't a classical C-section, but a low transverse section. I got back to her the same day and told her she had nothing to worry about."

Medem officials would like to make other e-services available to users, including digital appointment reminders and referrals, electronic claims data, and online compliance programs. Further down the electronic highway, officials see Medem as the prototype of a basic cable network for physicians, complete with premium channels offering special data and services.

The AMA: connecting physicians or targeting them?

Three months after the Medem launch, the AMA announced a joint venture with Acxiom, an international data management company headquartered in Little Rock. The new venture—given the snazzy name HealthCarePro Connect—has access to the AMA Physician Masterfile, which contains more than 870,000 physician records. The company is able to combine data in these records with information from a variety of other sources to create a "single view" of each physician. That means a doctor practicing in multiple locations will be identified as the same person, despite different addresses, different hospital and plan affiliations, and even different partners. The result is a gold mine for data-hungry marketers—something that the new company hopes to capitalize on.

Anticipating criticism that it was invading physicians' privacy, the AMA made sure doctors had the ability to access their profiles in order to correct or update information and indicate their contact preferences. Physicians who want to suppress certain forms of contact—direct mail or telephone solicitations, for example—will be able to do so.

"A doctor may indicate she wants pharmaceutical recalls e-mailed to her, but doesn't want to be blanketed or spammed by an online marketer," says Elizabeth Ruske, who worked at Acxiom before taking over as CEO at HealthCarePro Connect.

For some critics, however, these safeguards aren't enough. In published reports, they've charged the AMA with permitting pharmaceutical companies, among others, to "target specific doctors." And, alluding to the Sunbeam controversy, they've criticized the association for "once again treading close to the border of ethical propriety."

The AMA's Musacchio rejects these criticisms, pointing out that a physician has the right to be excluded from the database. And generally, he adds, "physicians don't mind being contacted. It's just the manner in which they're contacted that often bothers them."

That AMA is also competing for a share of the digital security market. In 1999, the doctor group and Intel developed AMA Internet ID, an authentication system for physicians who want to conduct secure online transactions. In simple terms, the technology—known as a digital certificate—guarantees that both the sender and recipient of a message or other data are who they say they are. The service was launched last December.

Then, in late April of this year, the AMA announced it would move into phase 2 of Internet ID development with a new partner, VeriSign, a specialist in Internet security. Officials at the AMA think the new partnership—and the enhanced Internet ID service—will push its share of the physician market from 1,200 "to 10 times that number" by year's end.

The AMA's main competitor in the security arena is the California Medical Association, which has a similar product. Thus far, the physician market for MEDePass, as the product and company are known, has been largely limited to California, although company officials are reaching out to medical societies in other states, including Georgia, Illinois, Indiana, Ohio, and Texas, to tap their physician markets.

Even supporters of digital certificates acknowledge there are problems, however. For one thing, until more companies that engage in online transactions with doctors sign up, physicians are restricted to talking among themselves. And even these doctor-to-doctor communications are limited by gaps in current application technology.

"Only a handful of e-mail applications today actually support digital certificates," says Folsom, CA, internist Michael Hogarth, a member of the MEDePass Health Care Professional Advisory Board. And those that do—like Microsoft's Outlook—make installation complicated enough so that "you have to have some knowledge of what you're doing."

Do doctors have the savvy to adopt the new technology?

Despite these challenges, the link between medical societies and e-commerce will likely grow stronger. In fact, even some of the smaller state and county medical societies are being bombarded by offers from e-commerce companies to partner up.

The Indiana State Medical Association, in cooperation with the Fort Wayne Medical Society, has agreed this year to test an electronic medical records application developed by an Austin, TX-based company. The Florida Medical Association capitalized on an existing relationship with Holland & Knight Consulting, the parent company of penMD.com, a Web portal, to give Sunshine State doctors access to an array of products and services. And in California, no stranger to e-come-ons, the Santa Clara County Medical Association announced last year it was endorsing PhysicianAccess.com and its product PAxNet, a new Internet-based practice management tool.

At the national level, the Chicago-based American Osteopathic Association and its new partner organization, the American Osteopathic Information Association, announced late last year the launch of DO-Online, which offers members a customizable Web site and the option to receive secure e-mail from patients.

Whether all this online wizardry finds a receptive audience among practicing doctors is uncertain, of course. "The big challenge is physician adoption," says Medem CEO Ed Fotsch, who thinks "physicians, by definition, think inside the box."

To help doctors make sense of it all, many societies have established e-commerce technical advisory committees. "I think it's important to offer our members guidance about what's proven and what's not," says surgeon Rami Saydjari, a member of the technical advisory committee of Indiana's state association.

Adds California pathologist Luke A. Perkocha, who sits on the CMA's E-Commerce Technical Advisory Committee: "Doctors aren't the Luddites many people think they are. When it comes to new technologies, they're good critical thinkers. They want to see demonstrated value—and they want to see things vetted. Sure, they aren't early adopters, but that's probably a good thing."

 

Wayne Guglielmo. Organized medicine’s new turf: e-services. Medical Economics 2001;14:47.